Commonwealth Relations

Lobbying Information Form Instructions

Please fill out the Lobbying Information Form and submit it by email, fax or campus mail to Governmental Relations in a timely manner for each quarterly reporting period.

In completing the Lobbying Information Form, please keep in mind the following parameters:

Please advise the University's Governmental Relations Office of all contacts with legislators or state officials on behalf of the University (contact Paul Supowitz or Charlie McLaughlin, 710 Alumni Hall).
Please return your completed form via the web or by fax (624-7707) to Governmental Relations on or before the 5th of the month (i.e., January 5, April 5, July 5 and September 5).
Where lobbying expenses on behalf of the University include events such as receptions, dinners or similar types of hospitality, the portion of the expenses attributable to legislators or state officials should be calculated on a per capita basis. For example, if the total cost of a reception which includes five legislators and 100 total attendees is $1,000, then the hospitality expense which should be reported for each legislator is 5% times $1,000 or $50.

If you have any questions regarding the Lobbying Information Form, please contact
Paul A. Supowitz in Governmental Relations (624-2901) or psupowit@pitt.edu.

Lobbying Information Form

For the three month period of (check one):

Jan - Mar
Apr - Jun
July - Sept
Oct - Dec

I. BACKGROUND

Your Name

Department & Position

Campus Address

Campus Phone

E-mail Address

No Activity or expenses this quarter

II. LOBBYING ACTIVITIES

1. Total time spent, on behalf of the University, on any and all effort(s) to influence legislative or administrative agency action (referred to as "Lobbying"),
including, preparation, time, such as research, writing, internal meetings and
discussions:

2. Total time spent, on behalf of the University, on any effort(s) to encourage others (such as alumni, staff and students) to take action to influence legislative or administrative agency action, including all preparation time:

3. Name and address of other persons who also participated or assisted in Lobbying effort(s) identified above, such as consultants, attorneys, researchers, support staff, etc.)

4. Briefly describe the subject matter of the Lobbying effort(s identified above:

5. Name(s) and title(s) of legislators or state officials whom you lobbied or with whom you had contact, on behalf of the University:

III. GIFTS AND HOSPITALITY

Identify all gifts, entertainment, meals, transportation, lodging and receptions for state officials, state employees or their immediate families:

Date

Name of State official/employee